tbuckley/cabot-search huggingface dataset:
Abstract 15686: Prevalence and Effects of Deep Vein Thrombosis on Hospital Outcomes Among COVID-19 Patients
Authors: Sandeep Appunni, Venkataraghavan Ramamoorthy, Md Ashfaq Ahmed, Zhenwei Zhang, Peter McGranaghan, Ramez Morcos, Joseph Salami, Muni Rubens, Anshul Saxena, Emir Veledar, Sandra Chaparro, Javier Jimenez
Journal: Circulation (2022)

Introduction: Current estimates show that, globally, there are 531 million cases and 6.3 million deaths due to COVID-19. Studies have shown that COVID-19 could lead to deep vein thrombosis (DVT) resulting in increased morbidity and mortality. In this study we sought to estimate the prevalence of DVT among COVID-19 hospitalizations as well as its effects on hospital outcomes using a large administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among DVT hospitalizations. Methods: We conducted a retrospective analysis of the 2020 California State Inpatient Database. All hospitalizations with age 18 and above and primary diagnosis of COVID-19 were included for the study. They were classified into those with and without DVT. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Length of stay ≥75th percentile was grouped as prolonged length of stay. Multivariate logistic regressions with covariate adjustments were conducted to compare COVID-19 related outcomes between those with and without DVT. Results: We included a total of 94,114 primary COVID-19 hospitalizations for the analysis. Among them 1575 (1.7%) had DVT. The prevalence of mortality (27.5% versus 11.1%, P&lt;0.001), prolonged length of stay (62.2% versus 27.8%, P&lt;0.001), vasopressor use (7.9% versus 2.1%, P&lt;0.001), mechanical ventilation (36.2% versus 9.7%, P&lt;0.001), and ICU admission (35.7% versus 9.3%, P&lt;0.001) were significantly higher among those with DVT. After adjusting for covariates, regression analysis showed that those with DVT had significantly greater odds for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusions: In our cohort, only few COVID-19 hospitalizations had a diagnosis of DVT. However, among those with DVT, the risk for adverse outcomes were significantly higher. Since DVT among COVID-19 is uncommon but associated with adverse hospital outcomes, healthcare providers should promptly monitor for DVT and manage it.
Abstract 261: Association Of Neighborhood Social Determinants Of Health With Adverse Out-of-hospital Cardiac Arrest (OHCA) Outcomes Among Medicare Beneficiaries
Authors: Ka Ming G Ngai, Kevin Petrozzo, David Buckler, Alexis M Zebrowski, Brendan G Carr
Journal: Circulation (2022)

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death with prior studies demonstrated worse OHCA outcomes in neighborhoods with higher proportion of Blacks and lower socioeconomic status. The association between OHCA outcomes and other social determinants of health (SDOHs) like limited English proficiency (LEP) and education is not well studied. Hypothesis: We hypothesized patients living in neighborhoods with high proportion of LEP had worse OHCA outcomes. We chose survival to hospital admission as the primary outcome due to its proximity to reflect a neighborhood’s characteristics. Methods: We performed a two-level hierarchical logistic-regression model. Patient data were Medicare fee-for-service claims between January 1, 2013, and December 31, 2015 (level 1). Neighborhood characteristics for the area in which each OHCA occurred were derived from the 2014 American Community Survey at the ZCTA level (level 2). We identified six neighborhood SDOH predictors of interest including LEP, median household income, racial and ethnic-group composition, percent unemployment, less than high school education, and population density. Results: Among the 194,231 OHCA events identified, 60,760 (31.3%) survived to hospital admission. Contrary to our hypothesis, Patient who had a cardiac arrest in the highest proportion of LEP neighborhoods were more likely to survive to hospital admission as compared to those living in predominantly English-speaking neighborhoods (OR 1.16; 95% CI, 1.10 to 1.23). Household income, racial composition, and unemployment had no effect on the likelihood of survival to hospital admission in OHCA while education and population density appeared to be protective (Table) . Conclusions: In a large cohort study, we found that patients who had an out of hospital cardiac arrest were more likely to survive to hospital admission in higher LEP, higher education, and higher population density neighborhoods.
Abstract 15333: Use of Wearable Devices by Patients With and At-Risk for Cardiovascular Disease in the United States: A Nationally Representative Study
Authors: Lovedeep S Dhingra, Arya Aminorroaya, Evangelos Oikonomou, Arash Aghajani Nargesi, Rohan Khera
Journal: Circulation (2022)

Background: Wearable technologies have increasingly been leveraged for management of cardiovascular disease (CVD) and present avenues for artificial intelligence-driven innovation. To evaluate the equitability of their potential impact, we evaluated their adoption in a nationally representative study. Methods: Using the nationally representative Health Information National Trends Survey (HINTS) study for 2019-2020, we examined the self-reported use of wearable devices among both patients with CVD (ischemic heart disease or heart failure) and those with risk factors (hypertension, diabetes, smoking, and/or obesity). We evaluated the patterns of their use across demographic subgroups of age, sex, race, income, and education as well as the willingness to share data for healthcare applications. Results: Of the 9303 individuals in HINTS, 933 had CVD (69±14 years, 47% women) and 5,185 were at risk of CVD (59±16 years, 58% women). An estimated 3.6 million individuals in US with CVD (18% of CVD, 95% CI: 14-29%) and 34.4 million (26% of at-risk, 95% CI: 24-28%) at-risk of CVD used wearables, compared with an estimated 29% of the total US population. Despite representing 49% and 22% of the CVD and at-risk populations, only 12% and 14% patients over 65 years had any wearable use, compared with 17% and 25% in 50-64 year, and 33% for both in 18-49-year group. Further, a higher annual household income and educational attainment was associated with 3- to 4-fold higher wearable use (Table). However, among users, 81% (95% CI: 76-85%) of the patients at risk of CVD would favor sharing wearables data to improve their care without differences across demographic subgroups. Conclusion: Demographic subgroups with the known worse cardiovascular outcomes have the lowest use of wearable devices among patients with or at risk of CVD. Unless wearables are supported as health devices, their disparate uptake is likely to further exacerbate disparities in patient outcomes.
Abstract 15858: Increased T Wave Amplitude in Lead Avr is a Strong Predictor of Reduced Left Ventricular Ejection Fraction in Suspected Acute Coronary Syndrome
Authors: Abdullah Ahmad, Majd Daoud, Ziad Faramand, Salah S Al-Zaiti
Journal: Circulation (2022)

Introduction: Non-invasive screening tools of cardiac function can play a significant role in the initial triage of patients with suspected acute coronary syndrome. Numerous ECG features have been previously linked with cardiac contractility in the general population. We sought to examine the prognostic value of positive T wave in lead aVR as a simple marker for real-time screening of reduced left ventricular ejection fraction (LVEF) in suspected acute coronary syndrome. Methods: We performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. The parent study recruited consecutive patients evaluated at the emergency department of three UPMC-affiliated tertiary care hospitals. We included consecutive patients in whom an echocardiogram was performed during indexed encounter. LVEF were retrieved from the cardiologist-signed report. Baseline 12-lead ECGs were preprocessed using manufacturer specific algorithms. Amplitude of T wave in lead aVR were automatically measured at T peak in millivolts. Data analysis was performed using SPSS and alpha was set at 0.05 for two-sided hypothesis testing. Results: Our sample included 313 patients (aged 63 ± 15, 45% females, 35% Black). The mean LVEF was 57±13%. Most patients were in normal sinus rhythm (87%) or atrial fibrillation (13%). In Bivariate analysis, there was a significant and negative correlation between T wave amplitude in lead aVR and LVEF (Pearson r = -0.173, p = 0.002). T wave amplitude in lead aVR was significantly larger in patients with LVEF &lt; 35% compared to their counterparts (-65±185 vs. -165±180, t(311) = -3.18, p = 0.002). Conclusions: Increasing T wave amplitude in lead aVR indicates lower LVEF in suspected acute coronary syndrome. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function during emergency care.
Abstract 207: Performance Of The Universal Tor Rule For Out-of-hospital Cardiac Arrest Cases Not Witnessed By Ems Providers In The Pan Asian Resuscitation Outcomes Study
Authors: Atsunori Onoe, Kentaro Kajino, Wei Ming Ng, Tanaka Hidhearu, Takashi Tagami, HYUNHO RYU, Chih-Hao Lin, Marcus Ong, Yasuyuki Kuwagata
Journal: Circulation (2022)

Introduction: In order to make effective use of limited medical resources in an aging society, ILCOR emphasizes the importance of considering the Termination of Resuscitation (TOR) rule in the prehospital setting. In Europe and the United States, the Universal TOR rule (no prehospital cardiac resumption, no witnessed by EMS, no shock at the scene) is utilized in the field. We used the Pan-Asian Resuscitation Outcomes (PAROS) data to examine cases of out-of-hospital cardiac arrest not witnessed by EMS providers in Singapore, Japan, Korea, and Taiwan. We also examined the validity of Universal TOR rule. Methods: This was a retrospective cohort study examining data from January 1, 2009 to June 31, 2018 of the Pan Asian Resuscitation Outcomes Study. We included patients with OHCA who were non-traumatic cardiac arrest and not witnessed by EMS providers. We examined the background of the patients, activities and response times of EMS, and survival outcomes. Then, we calculated the specificity, positive predictive value, etc. of cases that met the Universal TOR rule for poor neurological outcomes (CPC ≥ 3) . Results: The breakdown of cases was as follows: Singapore (10,976)/ Japan (117,814)/ Korea (17,926)/ Taiwan (17,063). Of these, Singapore 440 (4.0%)/ Japan 6,845 (5.8%)/ Korea 1,522 (8.5%)/ Taiwan 1,190 (7.0%) were discharged alive, and Singapore 263 (2.4%)/ Japan 3,791 (3.2%)/ Korea 679 (3.8%)/ Taiwan 457 (2.7%) were discharged alive for CPC 1 and 2. For CPC≥3 cases, the specificity of the universal TOR rule was Singapore 0.970/ Japan 0.912/ Korea 0.887/ Taiwan 0.742, and the positive predictive value was Singapore 0.999/ Japan 0.997/ Korea 0.995/ Taiwan 0.992. Conclusions: The positive predictive value for poor neurological prognosis at 1 month, among Universal TOR rule-compliant cases in the four countries was more than 99%. However, there were differences in the specificity of poor neurological outcome between countries.
Abstract 15487: Boosting Autophagy for the Reduction of Diabetes-Induced Endothelial Dysfunction
Authors: Maurizio Forte, Sonia Schiavon, Leonardo Schirone, Daniele Vecchio, Luca D'Ambrosio, Giacomo Frati, Sebastiano Sciarretta
Journal: Circulation (2022)

Introduction: Diabetes is one of the main cause of endothelial dysfunction. The molecular mechanisms underlying the effects of hyperglycaemia in endothelial cells still need to be clarified. Autophagy, a stress-responsive and self-renewal mechanism exerts beneficial effects in the cardiovascular system. However, its role in diabetes-induced endothelial dysfunction is unknown. Hypothesis: Endothelial autophagy is impaired in the presence of diabetes and restoration of autophagy may reduce diabetes-induced endothelial damage. Methods: The effects of hyperglycaemia (HG, 30 mM for 6 and 24 hours) on autophagy, mitophagy and endothelial function were evaluated in vitro in human umbilical endothelial cells (HUVEC). Vascular reactivity experiments were performed in mesenteric arteries from wild-type mice (WT) treated with HG and in human saphenous veins from patients with peripheral artery diseases. Autophagy reactivation was carried out through ATG7 overexpression (ATG7ov) or through spermidine (SP) (100 nM), a natural activator of autophagy and inhibitor of p300. Results: HG reduces autophagy (0.6 fold p&lt;0.05) and mitophagy (1.5 fold p&lt;0.001) in endothelial cells. HG also inhibits stress-induced autophagy in cells undergoing hypoxia (0.6 fold p&lt;0.05). ATG7ov rescues apoptosis (0.52 fold p&lt;0.05) and angiogenesis (2.3 fold p&lt;0.05) in HUVEC exposed to HG treatment. We found increased expression of the histone acetyltransferase p300 (2.27 fold p&lt;0.05), a known inhibitor of autophagy. Knockout mice of autophagy (Beclin 1 +/-) show a reduction in endothelial-dependent vasorelaxation compared to WT mice in response to HG (-19.16 % +-4.97 SEM vs -48.39 % +-2.18 SEM p&lt;0.001). Autophagy reactivation through ATG7ov or spermidine rescues endothelial-dependent relaxation in WT mice treated with HG (ATG7ov -62.48 % +-5.16 SEM; SP -63.01 +-3.22 SEM; HG -40.67 % +-3.82 p&lt;0.001). Finally, we demonstrated that SP improves vascular function in human veins (-37.6 % +-12.76 SEM vs -12.52 % +-5.6 SEM p&lt;0.001). Conclusions: The impairment of autophagy in response to diabetes contributes to endothelial dysfunction. Boosting autophagy with natural activators of autophagy may be a suitable intervention to reduce vascular damage in the presence of metabolic stress.
Abstract 15572: Utility Trends and Outcomes of Fractional Flow Reserve (FFR) in Diagnostic Coronary Angiograms for Patients With Stable Angina: National Readmission Database (2016-2019)
Authors: Fares Ghanem, Mohammad Alshami, Huthaifah Aburumman, Manar H Jbara, Vijay K Ramu, Bhavesh Gajjar, Ahmed Altibi, Yaman Mkhaimer, Laith Alhuneafat, Jeetendra B Patel
Journal: Circulation (2022)

Background: In patients with intermediate severity stenosis in a coronary artery, FFR has become the gold standard to measure myocardial ischemia and facilitate the clinical decision regarding the need for revascularization. However, when compared to angiography, it is still underutilized in clinical practice to guide PCI. Our research investigates the difference in outcomes between angiography with versus without the measurement of FFR in real-world data. Methods: National readmission databases 2016-2019 were used to identify patients with CAD undergoing coronary angiogram with versus without FFR using ICD-10 codes. We excluded cases who had Acute Coronary Syndrome (ACS), revascularization by PCI or CABG in the index admission or was performed in the last 6 months of each year to allow time for follow-up. Primary outcomes of the study were 6-months ACS admissions, Secondary outcomes include 6-months revascularization by PCI or CABG and mortality. We matched both cohorts using propensity score matching (PSM) and performed logistic regression to compute the odds ratios (ORs) and corresponding 95% confidence intervals (CI). Results: Out of 1,039,508 angiography procedures done in the USA, 68,767 (6.6%) cases FFR were used, trends of FFR utilization are noted in figure 1. After propensity score matching, our cohort included 31,469 patients with angiography alone and 31,637 angiography with FFR. At six months of follow-up, there was no significant difference in readmission rates due to ACS, OR 0.84 (95%, 0.69-1.03, P=0.098) or revascularization by PCI/CABG, OR: 1.07 (95% CI, 0.92-1.23, P=0.39). However, there was a significant reduction in mortality in the FFR group compared to the angiography alone group OR 0.81 (95% CI, 0.69-0.94, P&lt;0.01). Conclusion: In this nationally representative cohort, our study shows that angiography with FFR is associated with decreased mid-term mortality. In the USA, FFR utilization rate during Angiography remains minuscule (6.6%).
Abstract 180: Impact Of Hot Debriefing Programs On Pediatric Cardiopulmonary Resuscitation Quality And Outcomes
Authors: Priti Jani, Todd Sweberg, Maya Dewan, Ken Tegtmeyer, Paul Mullan, Heather Griffis, Xuemei Zhang, Dana Niles, Vinay M Nadkarni, Heather Wolfe
Journal: Circulation (2022)

Introduction: Successful cardiopulmonary resuscitation (CPR) outcomes rely on AHA guideline compliant chest compressions (CC). Resuscitation teams struggle to achieve these CPR metrics. Cold debriefing has led to higher quality CPR and improved patient outcomes. The impact of hot debriefing (HD) on CPR quality and patient outcomes is unknown. We sought to evaluate the association of HD on CPR quality and patient outcomes. Methods: Retrospective cohort of in-hospital cardiac arrests (IHCA), 0 to 18yo with complete quantitative CC metrics in the pediRES-Q database (1/2018 - 3/2021). We investigated exposure to HD, defined as hospital HD rate &gt;50% in the 12 months prior to the CPR event, with AHA compliant CPR (CC fraction (CCF) ≥0.80, CC rate (CCR) 100-120/min, and CC depth (CCD) &lt;1yo ≥3.4 cm, 1-8yo ≥4.4 cm, &gt;8yo 4.5≥6.6 cm). HD vs. non-HD events by CPR quality were compared via Chi-square or Wilcoxon rank sum tests and stratified by age. For index events, we evaluated return of circulation (ROC), survival to hospital discharge (SHD) and favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1, 2, or no change from baseline). Multivariable logistic regressions with a Generalized Estimating Equation method, adjusted for age group, arrest duration, initial rhythm, illness category, and site clustering. Results: We evaluated 515 IHCA events stratified by HD exposure (221 w and 294 wo) and age. Across age ranges, there was no difference in CCD or CCF between groups. Median CCR was lower in HD exposure groups: &lt;1yo, 110 vs 117 (p &lt;0.001), 1-8yo, 110 vs 117 (p &lt;0.001) and 8-&lt;18yo, 110 vs 115 (p =0.003). There was no difference in compliance with a composite of CCF + CCR + CCD. The composite CCR + CCF had increased compliance in the HD exposure groups: &lt;1yo, 37% (34 of 92) vs 21% (21 of 102) (p = 0.02), 1-8yo, 38% (27 of 72) vs 23% (26 of 111) (p = 0.05) and 8-&lt;18yo, 42% (24 of 57) vs 25% (20 of 81) (p = 0.04). To assess patient outcomes, we evaluated 917 index arrests (255 w HD exposure and 662 wo). On multivariable analysis, no significant difference was found for ROC, SHD or favorable neurologic outcome by HD exposure. Conclusion: Pediatric IHCA events with HD exposure demonstrated improved CPR metrics for CCR and CCF. No association was identified for patient level outcomes.
Abstract 15630: Association of Frailty With 30- and 90-day Outcomes in Patients Admitted With Heart Failure With Reduced Ejection Fraction (hfref) and Heart Failure With Preserved Ejection Fraction (hfpef)
Authors: Sumitabh Singh, Neha Mulpuri, Nitin Kondamudi, Lin Zhong, Ambarish Pandey
Journal: Circulation (2022)

Background: Frailty is associated with adverse post-hospitalization outcomes among patients admitted with heart failure. Whether frailty associated risk of adverse events among HF patients differs by HF subtype (HFpEF vs. HFrEF) is not well-established. Methods: Using Medicare claims data, we identified patients newly hospitalized for HF in 2016 within a cohort of 5% fee-for-service Medicare beneficiaries and used ICD-10 codes to specify HF subtype. Frailty was quantified using the Hospital Frailty Risk Score (HFRS), which computes frailty using 109 ICD-10 codes within 3 months of the index HF hospitalization. The association of HFRS with risk of outcomes were assessed using adjusted Cox proportional hazard models and multiplicative interaction testing was performed for HF subtype and HFRS. Improvement in model discrimination with addition of HFRS was assessed using change in the C-statistic and the integrated discrimination improvement test (IDI). Results: The study cohort included 14,276 Medicare beneficiaries hospitalized for HF [mean age (SD), 79 (8.4); 53 % women; 88 % white], among them 6836 (48%) with HFpEF and 3586 (25%) with HFrEF. In adjusted Cox models, higher frailty burden was associated with greater risk of 30- and 90- day mortality among beneficiaries hospitalized for HFrEF and HFpEF (Table 1). For readmission outcomes, higher frailty burden was associated with a significantly higher risk of 30-day and 90-day readmission among patients with HFpEF but not HFrEF (p-interaction HFRS * HF subtypes = 0.03 for both, Table 1). Addition of HFRS significantly improve discrimination to predict readmission. [30-day readmission, IDI (95%CI) = 0.011 (0.006-0.016)]. Conclusion: Higher frailty burden is significantly associated with increased risk of mortality in patients with HFpEF and HFrEF. In contrast, frailty is more strongly associated with risk of readmission (30-day and 90-day) among patients with HFpEF only but not among HFrEF.
Abstract 15798: Prevalence and Effects of Pulmonary Embolism on Hospital Outcomes Among COVID-19 Patients
Authors: Sandeep Appunni, Venkataraghavan Ramamoorthy, Zhenwei Zhang, Md Ashfaq Ahmed, Peter McGranaghan, Joseph Salami, Ramez Morcos, Muni Rubens, Anshul Saxena, Emir Veledar, Javier Jimenez, Sandra Chaparro
Journal: Circulation (2022)

Introduction: Approximately 531 million cases of coronavirus disease 2019 (COVID-19) has been reported globally, leading to 6.3 million deaths. Many studies have previous studies have reported that PE is a significantly dangerous complication of COVID-19. Therefore, we explored the prevalence of PE among COVID-19 hospitalizations. We also looked for the adverse effects of the coexistence of these two conditions using a large administrative database. Hypothesis: PE among COVID-19 hospitalizations could significantly increased the risk for adverse in-hospital outcomes. Methods: Using a retrospective analysis of the 2020 California State Inpatient Database we identified all COVID-19 hospitalizations and PE using ICD-10-CM codes among patients aged 18 years and above. Several outcomes such as in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were explored for differences between those with and without PE. Prolonged length of stay was defined as hospital length of stay ≥75th percentile. We used multivariate logistic regression analyses to understand the relationship between PE and adverse hospital outcomes after accounting for cofactors. Results: A total of 94,114 COVID-19 hospitalizations were included for the analysis, of which 1798 (1.9%) had PE. COVID-19 hospitalizations with PE had significantly greater rates of adverse hospital outcomes such as mortality (19.5% versus 11.2%, P&lt;0.001), prolonged length of stay (40.0% versus 28.2%, P&lt;0.001), vasopressor use (4.6% versus 2.1%, P&lt;0.001), mechanical ventilation (20.4% versus 9.9%, P&lt;0.001), and ICU admission (19.6% versus 9.6%, P&lt;0.001). PE significantly increased the odds of for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusions: Though very few COVID-19 hospitalizations in our cohort had PE, they had greater risk for adverse hospital outcomes and death. Given these adverse associations, PE among COVID-19 patients should be aggressively treated in order to decrease the disease burden of COVID-19.